Palliative and end of life care Resources

A syringe driver is a device used for administering medications subcutaneously to patients in a range of healthcare settings (Dickman and Schneider, 2016). However, this device is most commonly used in palliative and end-of-life care, which this article will focus on. They are small, battery-operated devices allowing portability and discretion, which are placed under the skin (subcutaneously) and typically infuse medication over 24 hours before requiring replenishment (Marie Curie, 2021). Using a syringe driver does not always signify that a person has reached the last days of their life. Instead, they function as a convenient method of administering medication for those patients who are unable to take prescriptions orally. The Scottish Palliative Care Guidelines (2020) explain that their use is valuable for patients who are experiencing bowel obstruction, malabsorption, nausea, vomiting, dysphagia or reduced consciousness, such as that seen towards the end of life.

The Paul Sartori Foundation is a charity based across Pembrokeshire in South West Wales, providing care free of charge to patients in the later stages of life limiting illness in their own homes. Its mission is to ‘provide excellent end-of-life care to the people of Pembrokeshire’. I facilitate and co-ordinate the clinical training for staff and some relevant others. This includes statutory training, as well as topics identified as being relevant to the care provided, for example, delirium, how we can support carers, and dementia. The Paul Sartori Foundation is a charity based across Pembrokeshire in South West Wales, providing care free of charge to patients in the later stages of life limiting illness in their own homes. Its mission is to ‘provide excellent end-of-life care to the people of Pembrokeshire’. I facilitate and co-ordinate the clinical training for staff and some relevant others. This includes statutory training, as well as topics identified as being relevant to the care provided, for example, delirium, how we can support carers, and dementia. 

Pressure injuries are sometimes considered to be due to a lack of good nursing care. However, it has been debated as to whether the development of some pressure injuries at the end of life is inevitable. More recently, the term ‘skin failure’, which occurs in dying patients, has been introduced in the wound care literature, and it is proposed that the presence of skin failure may make pressure injury inevitable. This article defines the theories around skin failure and presents the different terminologies used to describe skin damage typically found in the dying patient, such as the Kennedy ulcer and Trombley- Brennan terminal tissue injury (TB-TTI). It also discusses the importance of healthcare professionals being able to recognise that skin changes, which appear to be pressure injuries, are due to skin failure at the end of life and be able to differentiate between these and usual pressure injuries when planning and delivering care for these patients.

The importance of a well trained workforce to support the needs of those approaching the end of their life and the needs of their carers is readily acknowledged, yet relatively few healthcare professionals are specifically trained to manage palliative and end of life care. Access to suitable education is often patchy and many health and social care providers have difficulty accessing relevant education and training. This paper reflects on a Palliative and End of Life project for assistant practitioners being delivered in the North West of England.

Joanne Smith BA Hons, MSc, PGCE, Programme Leader, Foundation Degree, Health and Social Care, University of Bolton

Trish Brown RGN, PGDPNS, MA Gerontology Work Based Education Facilitator, UHSM Academy

Article accepted for publication: February 2012